Predicting Subclinical Cardiovascular Disease in HIV-infected Women using a Biomarker Score 公开

Moran, Caitlin Anne (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/bk128b67q?locale=zh
Published

Abstract

HIV infection is a well-established independent risk factor for cardiovascular disease (CVD). The risk of CVD is especially increased among younger individuals and women with HIV, compared with age- and sex-matched controls in the general population. However, CVD risk-stratification tools underperform in this setting. Biomarkers, including high-sensitivity C-reactive protein (hsCRP), d-dimer, heat shock protein 70 (HSP-70), and bilirubin, are associated with CVD risk in the general population, but their utility in enhancing CVD prediction in the HIV-infected population is unknown. In this retrospective cohort study of HIV-infected and at-risk HIV-uninfected women in the Women's Interagency HIV Study (WIHS) vascular substudy, hsCRP, d-dimer, HSP-70, and bilirubin, levels measured at the initial substudy visit above or below pre-specified cutpoints made up a composite biomarker score from 0-4. Multivariable regression modeling was used to determine the association between the biomarker score and the presence and progression of subclinical CVD [increased carotid intima-media thickness (CIMT), development of common carotid artery (CCA) lesions (IMT >1.5 mm), and/or increased carotid artery echolucency] as measured by high resolution B-mode ultrasonography. 783 women (572 HIV-infected, 211 HIV-uninfected) were followed for a median of 6.6 years. The composite biomarker score was not associated with baseline prevalence or progression of subclinical CVD. However, in HIV-uninfected women, hsCRP was associated with CCA plaque progression [RR 2.00, 95% confidence interval (CI) 1.21-3.29, p=0.007] and CIMT progression (mean difference 5.4, 95% CI 0.2-10.7, p=0.04]. No association was seen in HIV-infected women. These findings suggest that the pathogenesis of CVD may be different in the setting of HIV infection and further research is warranted.

Table of Contents

Introduction 1

Background 3

Methods 7

Results 16

Discussion/Conclusions 20

References 25

Table 1: Baseline demographic and clinical data for all women and by HIV

serostatus and biomarker score 33

Table 2: Subclinical CVD outcomes for all participants and by HIV

serostatus and biomarker score 36

Table 3: Median baseline biomarker values for all participants by HIV serostatus 37

Table 4: Unadjusted odds ratios or mean differences for baseline CCA plaque

formation, CIMT, or carotid echolucency according to biomarker levels for all

participants, and by HIV serostatus 38

Table 5: Unadjusted odds ratios or mean differences for change in CCA plaque

formation, CIMT, or carotid echolucency according to biomarker levels for all

participants, and by HIV serostatus 41

Table 6: Adjusted odds ratios or mean differences for baseline CCA plaques,

CIMT, or carotid echolucency according to biomarker levels for all participants,

and by HIV serostatus 44

Table 7: Adjusted rate ratios or mean differences for change in CCA plaques,

CIMT,or carotid echolucency according to biomarker levels for all participants,

and by HIV serostatus 47

Figure 1: Study design for the WIHS vascular substudy 50

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
School
Department
Degree
Submission
Language
  • English
Research field
关键词
Committee Chair / Thesis Advisor
Committee Members
最新修改

Primary PDF

Supplemental Files